Patient Contact

It’s the summer holidays and I’m making myself useful working at the hospital again as a healthcare assistant (HCA).  Recent shifts have been in palliative care and it’s like when I volunteered but with added extra “messy” responsibilities. It’s a world away from my previous job but it’s rewarding to work with patients and other healthcare professionals. Some of them know I’m studying medicine and actively teach me too.

Recently I began taking observations, blood pressure, heart rate, oxygen sats… etc. These haven’t been my first contact with patients but they do feel as though I’m doing something more ‘doctor’ like.  First year medical school taught me what the numbers and observations mean so I’m beginning to grasp what’s going on with actual patients which is satisfying. With my looking a bit older, maybe the patients think I’ve done obs for years which I hope puts them at ease. Anyway, the practice will help with OSCEs in second year.

Although I’m getting used to it, the speed with which some people pass away still has me bewildered. A patient and I were chatting only a few days ago yet here I am preparing his body for the mortuary… upset relatives waiting outside…

Doctors, nurses and other HCAs tell me that they deal with so much bereavement by leaving it all behind when they walk out through the revolving doors. Yet I’ve seen a few healthcare professionals upset outside so it’s not always the case, we are after all, human.

I try to forget too but sometimes weeks and months later, patients faces, their voices and funny conversations we’ve had still pop into my head.  Flashbacks of what their bodies looked like, their diseases, accompanying smells which I sometimes wish I would forget.

I’ve often thought what a waste it is that all those memories, skills learnt, experiences and connections with other people in those minds are gone, it’s too final. I wonder if one day we’ll be able to record them somehow so that others can learn from them?

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Initiation into Healthcare Assistant Work

To partly fund my medical school habit I’ve been working part time as a healthcare assistant (HCA). I got the job through hospital volunteering. When they heard I was looking for NHS work, I was fortunate that they suggested I join them.

An agency provided training and then I was let loose onto the ward. Everyone on the agency’s books are blanket-texted when a shift becomes available and if you call them in time you can work that shift.

As a new HCA, I worried about doing something wrong because as a volunteer I was ‘protected’ from many tasks e.g. washing, changing or toileting the patients. HCAs get a lot more patient contact and hence more responsibility as well as doing the messy tasks. Although it was the same ward where I volunteered, everything I had to do now was new and  unfamiliar. Do I really have to wipe their bottom? Do I wash their face or do they wash it themselves? We can brush their teeth but we can’t cut patient’s nails or nostril hair because of health and safety – what else can’t we do?

There are all kinds of new things to learn about, infection control, slide-sheets, hoists, slings, pads, mesh pants, and wipes; domestic waste bags, laundry bags and stripey black & yellow obnoxious waste bags and red infectious waste bags… it’s a steep learning curve but nothing compared to the amount I guess I’m going to have to learn at medical school.

It’s difficult in other ways too. It’s a race against time when you’re wiping someone’s bottom and they’re frail and tired and need to sit back down because their legs are not going to hold them much longer, but the wipes are not getting any cleaner, no matter how many new wipes you’ve used.

At the same time the nursing team leader is shouting at you to hurry up because she wants you to help wrap up the body of a patient in the next room who has just passed away before rigor mortis sets in. The same patient who only last week you were having a jolly nice chat with. That makes one think about the time we have left and doing something useful with it.

When you’re changing someone’s pad (adult diaper) and you hear a gurgling noise and you intuitively know that something liquid, foul-smelling and brown is going to come squirting out of their back passage imminently but somehow you manage to ram a fresh pad between them and their bed and catch it all. They’re embarrassed, they apologise and you act as though it is absolutely normal and say that you’ll clean them back up in no time, that it’s no problem at all, it happens to everybody – and it often does.

I don’t like some of the messy jobs but they’re worse than they sound and some of the patients are so nice and you do it out of respect for them. These are the patients that never press their buzzers out of fear of troubling someone, others use it like hotel room service although they’re a minority.

As a HCA you become very intimate with the patient – too intimate for most.  They tell you things that they wouldn’t tell their doctors and even their families. From this point of view it actually is a kind of privilege. It’s also a bit surreal – you have all this personal knowledge of someone but you’re supposed to leave it all behind when you go home.

I’m doing this for the experience and because I like the contact with the patients. The nurses and other HCAs tell me that all this work will stand me in good stead for the future when I start seeing patients myself as a medical student and doctor. The team I work with are really helpful and absolutely brilliant. HCA work is both physically and emotionally demanding but the pay is ridiculously and unfairly low. As a volunteer I had a lot of respect for HCAs and after experiencing first hand the work involved I’ve got even more respect for them.

Once I qualify I’m going to help out HCAs all that I can (although I’m sure as a junior doctor they’ll most likely be helping me find my feet)